Visiting Your Doctor: What To Expect
Editor’s Note: This content has been verified by Anne Peters, MD, a professor of clinical medicine at the Keck School of Medicine of the University of Southern California and the Director of the USC Clinical Diabetes Programs. Dr. Peters is an active member is an active member on the Beyond Type 1 Science Advisory Committee.
An initial visit with your type 1 diabetes (T1D) health care provider (HCP) is generally more about discussing your diabetes, your glucose levels and your goals, rather than physically examining you. However, there is basic information that you HCP will need. At your first visit they will discuss your medical, surgical and family history and get a sense of who you are and how to help you deal with your diabetes in the context of your life. You will get a basic physical exam, although often it is your primary care doctor who will be the one doing your more detailed annual physical examination. Diabetes doctors tend to concentrate on things like feeling your thyroid gland, listening to your heart, checking your feet and pulses and looking for any abnormalities at the places where you inject insulin or put in your infusion set. They may look in your eyes, but that doesn’t count as an “eye exam”—that should be done with eye photos or by an optometrist or ophthalmologist.
In terms of blood tests, at diagnosis and annually thereafter there are certain tests you need. These will be done more frequently if anything is abnormal. These tests include fasting lipids (cholesterol and triglyceride levels), a blood and urine test for your kidney function, tests of your thyroid function and anything else you HCP wants to test for.
Every three months you should have your “glycated hemoglobin level” or A1C measured. This can be done by a fingerstick in your HCP’s office or sent off to the lab from a blood draw. Either way it measures your three-month average glucose level. It is very useful because it gives you a sense of how you are doing overall, but it doesn’t tell you on a day to day basis what your sugars are. You could have lots of high and low sugars and have an A1C in the target range, but this might not be the best control for you. Newer ways of looking at your glucose values include time in range (TIR) (the time your sugars are between 70 – 180) and others. Ideally your A1C would be below 7% and your time in range 70% or more.
As you learn to manage your glucose levels with insulin, diet and exercise, these tests become a kind of status report that can help you see how you’re doing. The “score” does have some margin for error and can fluctuate, so it’s important not to place too much emphasis on it. Most importantly, if your results aren’t what you hoped, don’t get discouraged. The A1c is one tool among many that you and your doctors will be using to gauge how effective your treatment has been.
After the exams and the testing, it’s time to focus on education, and creating a plan for your future care. Typically you’ll want referrals to a CDE (certified diabetes educator) and a registered dietician (who may also be a CDE). You will need to have a referral to have your eyes checked. For many it is helpful to see a counselor or therapist to help deal with the emotions of having diabetes. It is important to review all vaccinations and make sure they are up to date. For women it is very important to see an Ob/Gyn or primary care provider to discuss reproductive health and birth control options, as needed. Women with T1D can have healthy, happy babies but pregnancies need to be planned.
Your diabetes team will want to work with you to build a custom treatment plan. Just as your T1D is unique to your body, the way you treat it will need to be customized to your life. Everyone has different fitness levels, work schedules, cultural activities and diet — all of which change over time — so there really isn’t a one-size-fits-all treatment. You need to be involved and aware of changing needs to maintain optimal health. There is no one goal in terms of A1C—you will work with your diabetes team to set appropriate goals for yourself. Never compare this with others—this is about you and what is best for you, not anyone else.
There will be many regular checkups to come, but you should leave your first visit with a plan, some goals and key information. Most importantly you need a “back up” plan–who to call if you have a problem. You need to know how you or someone in your family can reach you diabetes team in an emergency. Especially at first you may need lots of “hand holding” and frequent visits. This is fine—it is to be expected. You can never ask too many questions. You aren’t supposed to know the answers, at least not yet.
Know this –
- How to give yourself an injection. It sounds scary, but there’s not much to it after some practice. Your diabetes health care team will want to show you the basics and calm your fears.
- How to track your glucose levels in your blood—at first with a fingerstick and test strip, but also with a continuous glucose monitor at some point in the future, so you don’t have to do finger sticks much anymore.
- You will need to know how much insulin to give before meals and overnight, and how to adjust doses if you need to.
- Your team should teach you how to treat a low blood sugar reaction and what to do if you sugar levels are very high.
- How to give glucagon, which comes as a nasal spray, which someone could give you if your sugar falls too low and you can’t eat sugar yourself.
- How to test your urine for ketones, if needed—generally only done if you are sick or your sugars are very high.
- Emergency contact numbers for everyone on your team
- The names and doses of all your medications
- A follow-up appointment—to review all the basic and continue to adjust your treatment. Remember, you don’t have to learn everything all at once! Many diabetes teams will follow you remotely—through email or telemedicine visits, which may make it easier on you as you learn how to treat your diabetes.
The Months Ahead
There are some tests that your Doctor will reserve for annual visits, like screening for cholesterol levels, possible kidney issues, or eye exams, but another A1c test and a review of your diabetes management plan should occur every three months.
At each future appointment, you should:
- Bring any test results that you might have gotten from other doctors (paper versions or on your smart phone)
- Upload your devices as suggested by your diabetes team—that way the data is ready for analysis.
- Any other records you might have been keeping of your blood sugars, food and/or exercise.
- A list of your medications, especially if some have been changed by a different doctor. Also, it is very helpful to let your HCP know exactly what you need—which test strips, which lancets, which insulin, etc. Sometimes your insurance company will tell you which ones are covered. Updating your medication list and refilling everything possible at each in-person visit saves aggravation down the road.
- Bring a list of questions and concerns—it helps to have this written down in advance. You can even show it to your HCP. You want to maximize your time with your provider and be sure you feel that all your concerns are addressed.
- If you want to, it can be helpful to bring a spouse or a partner or a friend to your visits, especially at first. This isn’t necessary, as it is with children, but the people who love you will want to help you and engaging them in the process can be very reassuring for all.
Admittedly, regular doctor visits, quarterly blood tests and keeping close notes on your blood glucose levels might not sound fun … but regular medical visits are key in managing T1D. It’s tempting to skip appointments when life gets busy, but don’t. Meeting with your doctor can be reassuring and motivating.
The fact is, regular checkups and diligent tracking of your levels lead to fewer diabetes complications and will allow you to tackle this challenge with confidence.